Stroke Doctors Making Progress

March 24, 1985|The New York Times

NEW YORK — Doctors who have been looking for ways to prevent the severe brain damage that follows stroke say they may be on the verge of success, offering some victims their first hope of resuming normal lives.

In one of the boldest experiments, laboratory animals left brain-dead by strokes have been revived, with all their functions intact, by enriching their spinal fluid with oxygen.

Nothing so dramatic has been achieved in work with humans, but there is ``a whole new thrust,`` according to Dr. James Wood, director of the Cerebral Blood Flow Laboratory and an assistant professor at Emory University in Atlanta. ``We`re beginning to look at the cause and reverse tissue damage.``

Stroke, the death of brain cells after a blood vessel either leaks or is blocked, was seen until recently as an untreatable disease, an inevitable, often deadly, and usually incapacitating part of growing old. It is the nation`s third leading killer, after heart disease and cancer, yet most doctors have been able to do little more than help rehabilitate those who survive it.

`HOPELESS RESIGNATION`

``The attitude is that there`s nothing to be done,`` said Dr. Jewell Osterholm, chairman of the department of neurosurgery at Philadelphia`s Thomas Jefferson University. ``The attitude is hopeless resignation. We just put victims to bed. And, if they survive, they`re put in a nursing home.``

But some survivors are now being helped to resume productive lives with few of the handicaps that used to scar them.

Doctors can now recognize warning signs and control high blood pressure, which is linked to about half of all strokes. They can dissolve some clots that could block blood vessels in the brain, and prevent the formation of new ones. They are reopening clogged arteries with tiny balloons threaded along the blood vessels, and are learning to unclog them with lasers. They can also bypass the blockages with complex feats of microsurgery. They can thicken the blood and push it past a blockage in a blood vessel, or thin it and slip it past the plug. They are experimenting with enrichment of spinal fluid to reverse the effects of even the most catastrophic strokes.

Despite this progress, stroke research and therapy remains in its infancy, lagging behind the battles against such diseases as cancer or coronary heart disease. Many of the new treatments are experimental, too new to have provided conclusive, long-term statistical information. Though researchers differ on which treatments are most effective, they agree that they are making headway.

But apart from research and without doctors quite knowing why, the death rate from stroke has fallen by 46 percent from 1968 to 1981, the Journal of the American Medical Association reported last year, while the death rate from all diseases declined by 13 percent in the same period.

BETTER LIVING HABITS

Stroke specialists suspect this decline is largely the result of better living habits. They say Americans are eating healthier foods and exercising more. That reduces the buildup of fatty deposits on the walls of blood vessels, reducing the likelihood of strokes.

Researchers have uncovered much of the disease`s pathology with advanced brain scanners. Where stroke was once viewed as a single, devastating attack, it is now seen as a long-term circulatory disease similar to coronary heart disease.

In many ways, stroke is now understood as the brain`s version of a heart attack. Much like a heart attack, a stroke is caused by a buildup of fatty deposits on the artery walls. If an artery is blocked by these deposits, downstream tissues literally begin to starve. Or if a blood vessel`s wall, weakened by the deposits, tears, it spills blood and causes swelling and downstream starvation.

That process strikes 400,000 Americans every year, and kills nearly 165,000 of them, according to the American Heart Association. In addition, many people who survive the initial stroke remain severely impaired, unable to talk, read, or perform the simplest chores. They are imprisoned in unresponsive bodies, and many remain under intensive care in nursing homes for the rest of their lives.

Stroke victims account for an estimated 25 percent of residents of nursing homes. The aggregate bill for their care totaled more than $1 billion in 1976, the federal government has reported.